背景:类风湿性关节炎(RA)是一种以对称性多关节炎为特征的慢性炎性疾病。RA通常通过各种全身性药物进行治疗;另一方面,在全身用药失败的情况下,可以使用关节内皮质类固醇或不同类型的滑膜切除术。化学,放射性同位素,手术滑膜切除术被用作慢性滑膜炎的治疗选择,以改善关节功能。化学滑膜切除术耐受性不好,长期反应相对较低。手术滑膜切除术有较好的成功率,但它建议更高的费用。在放射性滑膜切除术中,放射性标记颗粒直接应用于关节腔,其次是接头的均匀分布。接下来,放射性粒子在滑膜深处运输,并被炎症细胞吞噬。最后,辐射导致先前发炎的滑膜纤维化和硬化;因此,它可以阻止炎症并减轻症状。它的成功率为40-100%,其效果与手术滑膜切除术相似。
方法:这项研究纳入了31名抵抗性单膝关节炎患者。通过美国指南将一毫千里磷32注射到患者的膝盖中。随后注入盐水以防止泄漏。在移除针后进行直接加压,并缓慢弯曲膝盖以确保均匀分布并用夹板固定1至2周。2周后对患者进行随访,1个月,2个月,和6个月。以下变量由治疗风湿病学家评估:患者疼痛,关节压痛,积液,和ROM。在注射时和第一周后,调查患者的任何并发症,包括感染,坏死,疼痛,和肿胀。临床特征和人口统计数据对现有并发症和疼痛变化的影响,关节压痛,积液,并对ROM进行了评估。
结果:这项研究纳入了31例患者,平均年龄为54.5±12.2岁,平均病程为12±6.5岁。我们患者的平均DAS-28ESR评分为4±0.7。疼痛,积液,在所有随访间隔后,减少的ROM显着减少。膝关节压痛在前2周没有受到影响,但在1、2和6个月后显著降低。通过我们的研究,没有报告严重的并发症,如感染和坏死。51.6%和54.8%的患者报告给药部位疼痛和肿胀。此外,19.4%和16.1%的患者报告在注射的第一周疼痛和积液恶化。
结论:在我们的研究中,我们证明了疼痛,压痛,积液,用磷-32进行放射性滑膜切除术后,ROM得到改善。我们还表明,没有严重的不良反应,如感染和坏死。然而,超过一半的患者在给药时出现注射部位疼痛和肿胀。关键点•我们证明了放射性滑膜切除术作为治疗单关节炎的药物的功效。•我们的研究结果可以导致更大的临床试验,以评估与局部或全身皮质类固醇治疗相比,放射性滑膜切除术的益处和不良反应。
BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by symmetric polyarthritis. RA is routinely treated by various systemic drugs; on the other hand, administration of intra-articular corticosteroids or different types of synovectomies can be used in case of systemic medication\'s failure. Chemical, radio isotopic, and surgical synovectomies are being used as therapeutic options for chronic synovitis to improve joint function. Chemical
synovectomy is not well tolerated, and the long-term response is relatively low. Surgical
synovectomy has a better success rate, but it recommends higher expenses. In radiation
synovectomy, radioactive labeled particles are applied directly in the articular cavity, followed by homogeneous distribution in joint. Next, the radioactive particles are transported in the depth of synovia and phagocytized by inflammatory cells. Finally, the radiation leads to fibrosis and sclerosis of formerly inflamed synovial membrane; thus, it stops the inflammation and reduces the symptoms. It has a success rate of 40-100% and its effect can be similar to surgical
synovectomy.
METHODS: Thirty-one patients with resistant monoarthritis of the knee were enrolled in this study. One millicurie of phosphorus-32 was injected into patients\' knee via US guide. Saline was injected afterwards to prevent leakage. Direct pressure was performed after removing the needle and the knee was flexed slowly to ensure homogenous distribution and fixed with a splint for 1 to 2 weeks. Patients were followed up after 2 weeks, 1 month, 2 months, and 6 months. The following variables were assessed by the treating rheumatologist: patients\' pain, joint tenderness, effusion, and ROM. At the time of injection and after the first week, patients were investigated for any complication including infection, necrosis, pain, and swelling. The effect of clinical characteristics and demographic data on existing complications and the changes of pain, joint tenderness, effusion, and ROM was assessed.
RESULTS: Thirty-one patients with the mean age of 54.5 ± 12.2 years and the mean disease duration of 12 ± 6.5 years were enrolled in this study. Mean DAS-28 ESR score for our patients was 4 ± 0.7. The pain, effusion, and reduced ROM were decreased significantly after all follow-up intervals. Knee tenderness was not affected in the first 2 weeks, but it was reduced significantly after 1, 2, and 6 months. No serious complications like infection and necrosis were reported through our study. 51.6% and 54.8% of our patients reported pain and swelling in the administration site. Furthermore, 19.4% and 16.1% of patients reported deterioration of pain and effusion in the first week of injection.
CONCLUSIONS: In our study, we demonstrated that pain, tenderness, effusion, and ROM are improved after radiation synovectomy with phosphorus-32. We also showed that there was no serious adverse effect like infection and necrosis. However, more than half of our patients experienced pain and swelling of injection site at the time of administration. Key points • We demonstrated the efficacy of radiation
synovectomy as a medication for monoarthritis. • The results of our study can lead to a bigger clinical trial to assess the benefits and adverse effects of radiation synovectomy in comparison to treatment with local or systemic corticosteroids.